tci Medicare Compliance & Reimbursement - 2011 Issue 9
Collections: Afraid You're Not Getting Paid On Time? Check Out Your State's Prompt Pay Laws
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Article Overview
This article covers prompt pay requirements for medical claims, including the difference between state insurance rules and federal Medicare timing expectations. It is aimed at medical practices, billing staff, and revenue cycle professionals who need to understand when claims should be paid, what happens when payment is late, and where to seek help through state insurance departments or medical societies.
Why This Topic Matters
Late payment on clean claims can disrupt cash flow and create administrative burden for practices. Understanding the general framework of prompt pay laws helps billing teams know when to escalate payment delays and where to look for state-specific guidance.
Article Sections
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Verify Which Laws Apply to Your Practice
Introduces the difference between state prompt pay requirements and federal payment timing. Discusses how practices can determine which insurers and claim types are covered.
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Hold Your Payers Accountable
Describes general steps a practice may take when a payer is consistently late paying claims. Covers documenting payment timing, escalating concerns, and contacting appropriate state resources.
What You Will Learn
- How prompt pay laws generally affect medical claim payment timing
- Why state rules may differ from federal Medicare payment expectations
- What broad types of resources can help practices identify applicable payer rules
- What general steps practices may take when payments are delayed
Who Should Read This
- Medical practice administrators
- Billing and coding staff
- Revenue cycle professionals
- Physician office managers
- Compliance and reimbursement staff
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